Inspection on 26/07/06 for West Heath House

This inspection was carried out on 26th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

West Heath House 07/11/08

West Heath House 31/01/08

West Heath House 17/02/06

West Heath House 04/11/05

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 West Heath House 54 Ivy House Road West Heath Birmingham West Midlands B38 8JW Lead Inspector Julie Preston Unannounced Inspection 26th July 2006 11:30 West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service West Heath House Address 54 Ivy House Road West Heath Birmingham West Midlands B38 8JW 0121 459 0909 0121 459 0910 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Brain Injury Rehabilitation Trust Mr Harminder Singh Kalsi Care Home 25 Category(ies) of Physical disability (25) registration, with number of places West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That home can accommodate up to 25 younger adults aged between 18-65 with acquired brain injury (25 PD) in receipt of personal care. 17th February 2006 Date of last inspection Brief Description of the Service: West Heath House is a purpose built care home for up to 25 adults with physical disabilities and acquired brain injury. The building is single storey and all bedrooms have en suite facilities. Communal areas consist of three lounges, two rehabilitation kitchens and two dining rooms. There are a number of rehabilitation staff working at the home that have office space and treatment rooms on the premises. The home is situated close to local amenities and public transport routes. The home is accessible to people that use wheelchairs and a number of aids and adaptations are provided in the home to assist them to manage their personal care. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key fieldwork took place over two days. Time was spent talking to service users about their experiences of living in the home and with staff about the work that they do. Records that explain how service users are cared for were looked at as well as records of staff training. A tour of the premises took place and the inspector had a meal with service users. The inspector looked at the way medicines are stored and given out and watched staff working with service users. There have been no complaints about this home since the last inspection. What the service does well: What has improved since the last inspection? Medicine management is much better which means that service users receive their medication in a safer way. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 6 Staff have had training in adult protection to help them understand what to do if individuals are harmed or at risk of harm. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. There are effective systems in place to assess the needs of prospective service users before they are admitted to the home. EVIDENCE: The inspector observed the assessment procedures for the admission of prospective service users to the home. Information was seen to have been gathered from a number of sources including the service user, healthcare professionals and family members as part of the assessment process. The assessment procedure used by the home was noted to be linked to the development of an individual plan that describes how service users assessed needs are to be met upon admission. It was pleasing to note that service users had been included in the assessment process. For example, written agreements were observed that had been devised with the service user to describe the care that would be provided and the systems in place to monitor the outcome of the delivery of such care. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 9 West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. There are effective systems of care planning and risk assessment in place to enable service users needs to be understood and met. Service users have opportunities to make decisions about their lifestyles. EVIDENCE: Three care plans were sampled, all of which contained clear information about service users’ assessed needs and the action to be taken by staff to enable those needs to be met. The home has a team of clinical staff including Psychologists, Speech and Language Therapists (SALT) and Occupational Therapists, who are based on the premises. The care plans sampled showed input from these professionals as part of individual rehabilitation programmes. It was evident from observation of care plans that service users had been included in their development and review. Four service users spoke to the West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 11 inspector about their care plans. All agreed that they had been involved in devising their plans and confirmed that they were aware of specified limitations and responsibilities, which had been identified as part of the review process. For example, one service user commented that he kept and administered his own medicines as part of his programme of rehabilitation. An assessment was observed which described the safeguards in place to reduce risk and promote independence for this person in this area. Staff present during this fieldwork demonstrated effective knowledge of service users needs, which was consistent with the individual care plans sampled. The home implements a system of risk assessment identification as part of the process of admission. The checklists sampled showed that identified risks and agreed controls to manage risks had been reviewed on a regular basis. It was pleasing to note that as a result of the risk assessment process, additional staffing had been provided for service users that require 1:1 support to assist them to take responsible risks. The home conducts a “client forum” every fortnight, to enable service users to discuss issues that are important to them in an open setting. Service users were observed to attend a forum meeting at this inspection to plan future group activities and look at making the home’s complaints procedure more accessible. Planning meetings are held where service users and staff agree tasks such as shopping, cooking and menu planning. Records of these meetings were observed and a number of service users commented that they liked being consulted about their rehabilitation programme. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by a team of trained staff to develop and maintain their skills in independent living. Activities are planned and varied. Staffing levels sometimes impact on the frequency of service users being able to go out. Service users are supported to keep in touch with their friends and relatives. Service users enjoy their meals and are included in food preparation and cooking. EVIDENCE: The inspector spent time with service users discussing the type of activities that were offered from the home, which included shopping, gardening, eating out, arts and crafts, visits to places of worship and bowling. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 13 Daily records sampled showed that activities had been logged, which detailed service users’ responses, including any refusal to participate in the activities offered which were further discussed in meetings between staff and the individual. Service users commented that they also take part in a number of rehabilitation tasks such as cooking, cleaning and laundry each day. A member of staff from the Occupational Therapy team stated that individual’s needs are assessed upon admission and rehabilitation programmes drawn up to enable service users to maintain and develop skills in independent living. Service users were observed cooking food, making drinks and cleaning their bedrooms during this fieldwork as part of their agreed rehabilitation programmes. Some service users and staff expressed concern that activities had been cancelled due to a lack of available drivers. This must be further explored to ensure that sufficient staff are on duty according to the needs of service users. The registered manager did respond that he believed sufficient numbers of staff were on duty to support activities to take place, however it was observed at this visit that activities had been cancelled at short notice to service users. The home has a visitor’s policy which is made available to service users and their friends and relatives. Examination of daily records showed that service users receive visitors to the home and spend time with their friends and relatives outside West Heath House. One service user commented that he telephoned his relatives every day and was able to make calls in private. The home has a large industrial style kitchen, which is staffed by two cooks. Smaller, domestic type kitchens are available for service users to cook their own food in, as part of individual rehabilitation programmes. The cooks advised the inspector that they take responsibility for the ordering of food, which is delivered to the home. The menu sampled showed that a range of meals were available, including Halal and vegetarian dishes. Appropriate facilities were observed for the storage and cooking of Halal meat products. The inspector had lunch with service users who made the following comments; “excellent”, “if I don’t like something I can have something else”, “there’s a good choice”. Service users also expressed their enjoyment of shopping for and cooking their own meals in the smaller kitchens. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 14 West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. There are effective systems in place to meet service users personal and health care needs. Medicines are well managed for the well being of service users. EVIDENCE: The individual plans sampled showed that service users personal care needs had been assessed and their preferred routines had been incorporated within the plan of care. For example, one plan made clear reference for the need to provide male staff for assistance with all personal care tasks in accordance with the service user’s cultural and spiritual beliefs. Evidence was seen in the form of assessments made by the Occupational Therapy team that service users who require assistance from staff and/or specialised equipment had guidelines in place to instruct staff how to meet their personal care needs. It was pleasing to note that these assessments included information about individual’s strengths and the need to enable service users to maintain their independence as much as possible. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 16 Health care records sampled identified that service users have access to a range of health professionals and that appointments are logged, which means that service users health care needs are being addressed. Health care review records showed that input is received from the home’s rehabilitation team, psychologists and the Consultant in Neuropsychology and Rehabilitation as part of the process in accordance with service users individual needs. Staff have been provided with training in moving and handling, in accordance with service users assessed needs. Medicines were seen to be securely stored within the home. Written protocols for the administration of PRN (as required) medicines were in place and staff demonstrated awareness of the circumstances under which they should be administered. Since the last inspection, written risk assessment protocols have been devised for service users that administer their own medicines to help them do so in safety. Staff at the home have received accredited training in the safe handling of medicines and the Head of Care advised that a supplementary medicines awareness day had been planned for the staff team to support their learning. Medicines were tracked for three service users. Stock had been recorded when received into the home and returned to the pharmacy. In one case a tablet of Carbamazepine had been signed for on the medication administration record, however the tablet was observed in its packaging. Immediate requirements were made that this be investigated, otherwise the records showed no anomalies. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. There are procedures in place for service users and their representatives to make complaints. There are systems in place to protect service users from harm and abuse. EVIDENCE: The home has a written complaints procedure which is made available to service users and their families. The procedure is being developed in picture format by SALT staff to be more accessible to service users who do not read written language. Service users told the inspector that they were aware of the procedure for making complaints. The complaints log was observed which described issues raised by service users and the action taken by the home in response. Referrals under adult protection procedures were noted to have been made by the home in response to incidents between service users. Within the records sampled it was evident that individual care plans and risk assessments had been reviewed following these incidents. A social worker who spoke to the inspector shortly after this visit stated that the staff team “demonstrate knowledge of adult protection procedures and make prompt referrals in response to events that take place”. Staff have received training in physical intervention and adult protection to enable them to promote the protection and well being of service users. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 18 West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 30 The quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally clean and warm throughout. Some minor repairs and limitation of access to the garden impact on what is a pleasant environment for service users to live in. EVIDENCE: West Heath House is a purpose built single storey building that, in the main has good facilities for people with a physical disability. The home is situated close to local amenities and has a large car park at the front of the building. The premises are not domestic in style, although effort has been made to personalise service users bedrooms and some communal areas. At this fieldwork it was noted that some service users who use wheelchairs found it difficult to access the enclosed gardens due to the layout of gravel and railway sleepers on the ground. This was discussed with service users and staff who said they felt that some parts of the garden were not ideal for wheelchair users and should be more accessible. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 20 The house rules permit smoking outside, however a number of wheelchair users were observed to sit smoking in the doorways to the garden and subsequently the carpet around these areas had been burned by cigarette ends. Two service users said that they couldn’t manoeuvre their wheelchairs down the ramps into the garden on their own to smoke. This must be explored to ensure that service users are supported to smoke safely and that the premises meets individuals needs. The registered manager commented that he believed the garden areas to be accessible to service users, however it was noted from observation and comments received from some individuals that gravelled space was difficult to manoeuvre around. Four bedrooms were observed, all of which were warm and clean and had been personalised to service users tastes. In one room a number of holes were seen in the walls, which must be repaired. The laundry room is situated away from areas where food is stored, prepared and eaten. It was reported by staff and evidenced within individual plans and daily records that service users are supported to do their own laundry where this forms part of their plan of care. A member of staff described the system of moving soiled linen from bedrooms and bathrooms to the laundry, which was consistent with the home’s written infection control policy and observed in practice at this visit. Clinical waste bins were seen to be in place throughout the building and the inspector was advised that the home has a contract for the regular removal of clinical waste. Both practices help keep the home clean and hygienic. The kitchen was noted to be clean and well organised with the exception of fly screens covering the windows, which need to be cleaned. An area at the rear of the kitchen was cluttered with items that the cooks stated were infrequently used, making access and cleaning difficult. This issue had been identified at a recent visit from the Environmental Health Department as in need of attention and must be addressed. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by a robust process of recruitment and selection and a knowledgeable and trained team of staff. EVIDENCE: Staff were observed working with service users at this visit. Some positive practice was noted, for example staff responded discreetly and sensitively to a service user who was clearly distressed and spent time with the person until they were calmer. Another member of staff took prompt action to help a service user get changed after her clothing became soiled at lunchtime. The inspector considered the approach of staff to be friendly and respectful to service users. A number of service users made comments about the staff team; “they (the Occupational Therapy team) have really helped me”, “the staff are all good here” and “I can always talk to X, she’s brilliant”. Some service users need 1:1 support for periods during the day and this was reflected in the daytime staffing rota observed. The inspector spent time talking to staff about working in the home and found them to be knowledgeable about service users needs and their role in West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 22 supporting individual’s to maintain and develop their independence. Several members of staff spoke about the value of having the clinical team based on site, which had helped them understand the importance of rehabilitation techniques. Staff recruitment records were sampled, which showed that checks had been made to establish employee’s suitability to work within the home prior to their employment commencing. The Head of Care Services confirmed that service users are included in the recruitment of new staff, records of which were observed to support this. Staff members commented that they had received a range of training opportunities including Brain Injuries Trust induction, adult protection, fire safety, crisis intervention and behaviour management techniques and first aid. The home’s training matrix identified a rolling programme to be in place, which covered, mandatory and training specific to service users individual needs. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The quality outcome in this area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and service users health and safety is promoted and protected. There is a system of quality assurance, which seeks the views of service users in the development of the home. EVIDENCE: The registered manager has had considerable experience of working in the adult care sector and has demonstrated a commitment to developing the service further for the benefit of the people who live there. Two assistant managers, both of whom hold a nursing qualification, support the registered manager in the running of the home. The assistant managers have knowledge and experience of working with the service user group and demonstrate good understanding of their role. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 24 A representative of the registered provider makes regular visits to the home in order to report on the standard of care provided. The registered manager and CSCI have received copies of these reports. Service users confirmed that they have opportunities to express their views at the client forum and in sessions with their key workers. The inspector was advised that West Heath House are working towards accreditation with the Commission on Accreditation of Rehabilitation Facilities (CARF), which involves a review of care practice, policy and procedure against CARF standards and includes a focus on the individual needs and rights of people that use the service. This means that service users will take a lead role in developing the service they receive. The home’s fire safety records were examined and showed that regular testing and servicing of the fire alarm system and fire safety equipment had taken place. Up to date certificates of service and maintenance were available for bathing and hoisting aids, gas and electrical appliances. This practice helps promote and protect service users safety in the home. A food safety report dated May 2006 was observed which identified the “good standards throughout”. Records were seen of quarterly health and safety meetings, chaired by an advisor to the Brain Injuries Trust, which identified areas in need of improvement within the home. It was evident from discussion with staff that action had been taken in response to the issues raised. West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 26 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA13 Regulation 18(1)(a) 12(3) Requirement Sufficient numbers of staff must be on duty to enable service users access to community based activities based on their needs and preferences. An investigation must be conducted into the possible medication error on 17/8/06 and appropriate action taken according to the outcome. Immediate requirement 3 YA24 23(2)(o) The layout of the enclosed gardens must be reviewed to ensure adequate access to service users who use wheelchairs. Action must be taken according to the outcome of this review. The registered manager must review the smoking arrangements for service users who use wheelchairs. Action must be taken according to the outcome of this review. DS0000024906.V305263.R01.S.doc Timescale for action 11/11/06 2 YA20 13(2) 24/08/06 11/11/06 4 YA24 23(2)(a) 13(4)(b, c) 11/11/06 West Heath House Version 5.2 Page 27 5 6 7 8 YA24 YA26 YA30 YA30 23(2)(b) 23(2)(b) 23(2)(d) 13(3) 16(2)(j) Carpets burned by cigarette ends must be replaced. The holes in the walls in bedroom number 26 must be repaired. Fly screens in the kitchen must be kept clean. The home must take action to clear the cluttered area in the kitchen identified in the Environmental Health report of May 2006. 11/11/06 11/11/06 11/11/06 11/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI West Heath House DS0000024906.V305263.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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